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Hospital mortality in surgery for reconstruction outflow right ventricle with pulmonary homograft
Andrea Weirich Lenzi1, Nelson Itiro Miyague, Wanderley Saviolo Ferreira
1Hospital Pequeno Príncipe Curitiba - PR, Brazil. andreawlenzi@yahoo.com.br
Insights
Surgical reconstruction of the right ventricle outflow tract using pulmonary homografts has an 18% hospital mortality rate. No specific risk factors were identified in this study of pediatric heart surgery patients.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Cardiovascular Surgery
Background:
- Hospital mortality rates for surgical right ventricle outflow tract reconstruction with pulmonary homografts are variable.
- Congenital obstructive right heart conditions often require early surgical intervention.
Purpose of the Study:
- To identify risk factors for hospital mortality in patients undergoing right ventricle outflow tract reconstruction.
- To describe the clinical profile of these pediatric patients.
Main Methods:
- Retrospective analysis of 92 children who underwent right ventricle outflow tract reconstruction with pulmonary homografts between 1998 and 2005.
- Evaluation of clinical, surgical, and prosthetic morphological factors as potential risk factors for mortality.
Main Results:
- The study included patients with pulmonary atresia, ventricular septal defect, and tetralogy of Fallot; 40% were treated within the first month of life.
- Seventeen deaths (18%) occurred, primarily due to multiple organ failure, with an average time to death of 10.5 days post-surgery.
- Univariate analysis suggested potential associations between mortality and age at surgery, homograft size, pulmonary valve Z-value, cardiopulmonary bypass time, and homograft/pulmonary tree integrity, but no statistical significance was found for any variable.
Conclusions:
- Congenital obstructive right heart disease necessitates surgical intervention early in life.
- While total correction surgery carried an 18% risk rate, no specific associated risk factors were identified among the variables studied.
Background:
Hospital mortality for surgical reconstruction of the outflow of the right ventricle with pulmonary homograft is variable.
Objectives:
To identify risk factors associated with hospital mortality and clinical profile of patients.
Methods:
Children underwent reconstruction of the outflow tract of right ventricle with pulmonary homograft. Analyzed as risk factors for the clinical, surgical and morphological aspects of the prosthesis.
Results:
Ninety-two patients operated on between 1998 and 2005 presented mainly pulmonary atresia with ventricular septal defect and tetralogy of Fallot. Forty patients were treated in the first month of life. He needed 38 surgeries to Blalock Taussig due to clinical severity. The median age at surgery for total correction was 22 months, ranging from 1 to 157 months. Size pulmonary homograft ranging from 12 to 26 mm and length of bypass was 132 +/- 37 minutes. After surgery there were seventeen deaths (18% cases) on average 10.5 +/- 7.5 days. The predominant cause was multiple organ failure. In the univariate analysis between the types of heart disease, they found in favor of age at surgery, size of homograft, pulmonary valve Z value, CPB time, maintaining the integrity of the homograft and pulmonary tree change. There was no statistical difference in hospital mortality between the variables and the type of heart disease.
Conclusion:
The congenital obstructive right requires surgical care in the first days of life. The total correction surgery has a risk rate of 18% but there was no association with any variable studied.
